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PHYSICAL AND COGNITIVE DEVELOPMENT IN ADOLESCENCE

CHAPTER 11

Learning Objectives

Explain: These are the questions we will consider as we begin our study of adolescence.

PHYSICAL MATURATION

Physical Manifestations of Puberty

Start of physical maturation:
Begins when the pituitary gland in the brain signals other glands in children's bodies to begin producing the sex hormones, androgens (male hormones) or estrogens (female hormones), at adult levels.
Males and females produce both types of sex hormones, but males have a higher concentration of androgens and females a higher concentration of estrogens.)
Pituitary gland also signals body to increase production of growth hormones that interact with the sex hormones to cause the growth spurt and puberty. In addition, the hormone leptin appears to play a role in the start of puberty.

Growth during Adolescence: The Rapid Pace of Physical and Sexual Maturation

Adolescent growth spurt

Weight increase
Skeletal changes
Accelerated
Asynchronicity in growth

Adolescence is the developmental stage that lies between childhood and adulthood. It is generally viewed as starting just before the teenage years and ending just after them. It is a transitional stage. Adolescents are considered no longer children, but not yet adults. It is a time of considerable physical and psychological growth and change.
One aspect of this transformation is the adolescent growth spurt, a period of very rapid growth in height and weight. On average, boys grow 4.1 inches a year and girls 3.5 inches a year. Some adolescents grow as much as 5 inches in a single year.
Boys’ and girls’ adolescent growth spurts begin at different times. As you can see in Figure 11-1, girls begin their spurts around age 10, while boys start at about age 12. During the 2-year period starting at age 11, girls tend to be taller than boys. But by the age of 13, boys, on average, are taller than girls—a state of affairs that persists for the remainder of the life span.

Wt and ht increase due to simultaneous release of growth hormone, thyroid hormones, and and androgens; peak height velocity at adolescence and toddler years
In general two years earlier in girls; girls taller between 11 and 13
Changes in composition of skeletal structure; closing of long bones; ethnic differences
Height changes in torso rather than leg length
Accelerated growth spurtextremities first (head, hands, feet) arms and legs torso and shoulder growth

Growth Pattern

Patterns of growth are depicted in two ways. The first figure shows height at a given age, while the second shows the height increase occurs from birth through the end of adolescence. Notice that girls begin their growth spurt around age 10, while boys begin the growth spurt at about age 12. However, by the age of 13, boys tend to be taller than girls. What are the social consequences for boys and girls of being taller or shorter than average? (Source: Adapted from Cratty, 1986.)

What is a secular trend?

Earlier start of puberty is example of significant secular trend
Pattern of change occurring over several generations
Trends occur when physical characteristic changes over course of several generations
Result of better nutrition over centuries

Puberty in Girls

Begins earlier for girls than for boys

Girls start puberty at around age 11 or 12, and boys begin at around age 13 or 14
Wide variations among individuals

Influences

Nutrition
Health
Environmental stress

For example, some girls begin puberty as early as 7 or 8 or as late as 16 years of age.

Onset of Menarche

Varies in different parts of world
Begins later in poorer, developing countries
Influenced by proportion of fat to muscle in body
Related to environmental stress

Figure 11-2 Onset of Menstruation

The onset of menstruation occurs earlier in more economically

advantaged countries than in those that are poorer. But even in wealthier countries, girls living in more affluent circumstances begin to menstruate earlier than those living in less

affluent situations. Why is this the case? (Source: Adapted from Eveleth & Tanner, 1976.)

Menarche, the onset of menstruation and probably the most obvious signal of puberty in girls.
Consequently, it appears that girls who are better nourished and healthier are more apt to start menstruation at an earlier age than those who suffer from malnutrition or chronic disease. In fact, some studies have suggested that weight or the proportion of fat to muscle in the body play a critical role in the timing of menarche.
Environmental stress due to such factors as parental divorce or high levels of family conflict can bring about an early onset.

Puberty in Boys

Penis and scrotum begin to grow at accelerated rate around age 12 and reach adult size about 3 or 4 years later
Enlargement of prostate gland and seminal vesicles
Spermarche around age 13

A boy's first ejaculation, known as spermarche usually occurs around the age of 13, more than a year after the body has begun producing sperm. At first, the semen contains relatively few sperm, but the amount of sperm increases significantly with age.

Primary Sex Characteristics

Further development of sex glands

Testes in males
Ovaries in females

Secondary Sex Characteristics

Changes in genitals and breasts
Growth of hair:
Pubic
Facial
Body
Further development of sex organs

In girls, the development of primary sex characteristics involves changes in the vagina and uterus.
Secondary sex characteristics include the development of breasts and pubic hair.
Breasts begin to grow at around the age of 10, and pubic hair beings to appear at about age 11. Underarm hair appears about 2 years later.
For some girls, indications of puberty start unusually early. One out of 7 Caucasian girls develops breasts or pubic hair by age 8. Even more surprisingly, the figure is 1 out of 2 for African American girls.

Body Image: Reaction to Physical Changes in Adolescence

Some of the changes of adolescence do not show up in physical changes, but carry psychological weight

Menstruation and ejaculations occur privately, but changes in body shape and size are public
Teenagers entering puberty frequently are embarrassed by the changes
Girls are frequently unhappy about their changing bodies

Sexual Maturation

The changes in sexual maturation that occur for males and females during early adolescence.

(Source: Based on Tanner, 1978.)

Timing and Tempo of Puberty

Variation of timing and tempo great

No relationship between onset and rate of pubertal development

Some differences; causes are inconclusive

Consequences of Early and Late Maturation

The Consequences of Early and Late Maturation

Nutrition, Food, and Eating Disorders:
Fueling the Growth of Adolescence

Fueling the Growth of Adolescence

For most adolescents, the major nutritional issue is ensuring the consumption of a sufficient balance of appropriate foods

Rapid physical growth of adolescence is fueled by an increase in food consumption
Particularly during the growth spurt, adolescents eat substantial quantities of food, increasing their intake of calories rather dramatically
During the teenage years, the average girl requires some 2,200 calories a day
The average boy requires 2,800
Several key nutrients are essential, including, in particular, calcium and iron

Nutritional Problems in Adolescence

Poor eating habits

High consumption of junk food/sugar/fats
Large portion sizes
Lack of variety

Related health concerns

Obesity
Osteoporosis
Diabetes
Heart disease

Nutritional Problems in Adolescents

The incidence of obesity among six- to eleven-year-olds in the US has more than doubled in the past 20 years (USDHHS, 2004). As reported by the Office of the Surgeon General (USDHHS, 2001), most young people are not following recommendations set forth in the Dietary Guidelines for Americans. For example, 67% of youths aged 6-19 exceed dietary guidelines for fat intake and 72% exceed recommendations for saturated fat intake.

Most nutritional problems in adolescents are related to the consumption of too much “junk food,” or food with limited or no nutritional value. Most junk food is characterized by high levels of fats, particularly saturated fats, and refined sugar. The portion sizes of junk food also typically are very large. In addition, most adolescents eat very few fruits and vegetables per day or chose items, such as iceberg lettuce, with low nutritional values.

The eating habits of today's adolescents will lead to future health care problems. Obesity is related to a number of health problems, including Type 2 Diabetes, heart disease, stroke and cancer (NHLBI, 2004). Osteoporosis also is a growing problem, even among adolescents. Poor nutrition and insufficient exercise both contribute to low bone density among teenagers.

References:

[NHLBI] National Heart Lung and Blood Institute, National Institutes of Health. (2004). Aim for a Health Weight (website). Retrieved 6-16-2004 from http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/index.htm

[USDHHS] US Department of Health and Human Services, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion. (2004).

Resource Guide for Nutrition and Physical Activity Interventions to Prevent Obesity and Other Chronic Diseases. Retrieved 6-16-2004 from http://www.cdc.gov/nccdphp/dnpa/obesityprevention.htm

[USDHHS] US Department of Health and Human Services. (2001). The Surgeon General's call to action to prevent and decrease overweight and obesity. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General.

Pubertal Changes and Eating Disorders

Ratio of body fat to muscle increases
Basal metabolism rate decreases
Overall physical appearance changes
20% overweight; 5% obese; 15% seriously overweight

Figure 11-4 No Sweat

Physical activity among both white and black adolescent emales declines substantially over the course of adolescence. What might be the reasons for this decline? Source: Based on Kimm et al., 2002.)

Anorexia Nervosa and Bulimia

Definitions

Anorexia=starvation to maintain low weight
Bulimia=binge and purge eating
1% anorexic and 3% bulimic
Higher incidence among females

Disordered eating and body dissatisfaction reported across socioeconomic lines

Brain Development and Thought: Paving the Way for Cognitive Growth

A No Brainer?????

Brain changes
Growth spurts
No clear 1:1 correspondence

Brain changes:
Size
Maturity
Growth spurts
Different part of brain
Different times
No clear 1:1 correspondence
With specific changes in brain size
With structures and intellectual changes in adolescence
As the number of neurons (the cells of the nervous system) continue to grow, and their interconnections become richer and more complex, adolescent thinking also becomes more sophisticated.

Use It or Lose It

Brain produces oversupply of gray matter during adolescence which is later pruned back at rate of one to two percent per year
Myelination increases and continues to make transmission of neural messages more efficient

Number of neurons (the cells of the nervous system) continue to grow.

Interconnections become richer and more complex.

Adolescent thinking becomes more sophisticated.

Myelination—the process in which nerve cells are insulated by a covering of fat cells—increases and continues to make the transmission of neural messages more efficient.
Both the pruning process and increased myelination contribute to the growing cognitive abilities of

How is this related to adolescent impulse control?

Prefrontal cortex provides for impulse control

Adolescence prefrontal cortex is biologically immature = ability to inhibit impulses is not fully developed

Figure 11-5 Pruning Gray Matter

This three-dimensional view of the brain shows areas of gray matter that are pruned from the brain between adolescence and adulthood. (Source: Sowell et al., 1999.)

Rather than simply reacting to emotions such as anger or rage, an individual with a fully developed prefrontal cortex is able to inhibit the desire for action that stems from such emotions.

The Immature Brain Argument: Too Young for the Death Penalty?

Are the brains of adolescents so immature that teenage offenders should receive less harsh punishment for their crimes than those with older, and therefore more mature, brains?

What do you think?

Yawning of the Age of Adolescence

Sleep Deprivation

Adolescents go to bed later and get up earlier
Sleep deprivation takes its toll
Lower grades
More depressed
Greater difficulty controlling their moods
Greater risk for auto accidents

Older adolescents in particular experience the need to go to bed later and to sleep later in the morning, and they require nine hours of sleep each night to feel rested.
Because they typically have early morning classes but don’t feel sleepy until late at night, they end up getting far less sleep than their bodies crave.

Review and Apply

rapid; puberty
confusion; self esteem
early; late; gender; psychological
nutrition; physical
obesity; eating

Review and Apply

anorexia nervosa; bulimia; physical; psychological
brain

Review and Apply

COGNITIVE DEVELOPMENT AND SCHOOLING

Cognitive Development

Approaches

Piaget
Information processing
Adolescent egocentrism

Piagetian Perspective

Fixed sequence of qualitatively different stages

Fundamentally different than child thinking

Utilized in variety of settings and situations

Incorporates new, more advanced, and more adaptive form of reasoning
Occurs when biological readiness and increasingly complex environmental demands create cognitive disequilibrium

Piagetian Stages Related to Youth Development

Formal operations

11+ years
Development of abstract and hypothetical reasoning
Development of propositional logic
Cultural differences in use

Developmental of Formal Operations

Emergent

Early adolescence
Variable usage depends on conditions surrounding assessment

Established

Late adolescence
Consolidated and integrated into general approach to reasoning

Consequences of Adolescents’ Use of Formal Operations

Ability to reason abstractly, embodied in their use of formal operations, leads to a change in their everyday behavior

Questioning parents and authority figures
Exhibiting greater idealism and impatience with imperfections
Experiencing indecision

Piaget…Pros and Cons

Pros

Catalyst for much research
Accounts for many changes observed during adolescence
Helps explain
Developmental differences
Multidimensionality
Metacognition

Cons

Fails to prove
Stage like fashion of cognition
FO is adolescent cognitive stage
Fails to account for variability
Between children
Within child
Within specific situations

Information Processing Perspectives: Gradual Transformations in Abilities

Changes in adolescents’ cognitive abilities are evidence of gradual transformations in the capacity to take in, use, and store information
Number of progressive changes occur in the ways people organize their thinking about the world, develop strategies for dealing with new situations, sort facts, and achieve advances in memory capacity and perceptual abilities
Incorporates same techniques to understanding human reasoning that computer scientists employ in writing programs

Changes in Information Processing

Gains during adolescence help to explain developmental differences in abstract, multidimensional, and hypothetical thinking
Store of knowledge increases as the amount of material to which they are exposed grows and their memory capacity enlarges

Egocentrism in Thinking: Adolescents’ Self-Absorption

New abilities make adolescents particularly introspective and self-conscious
These hallmarks of may produce a high degree of egocentrism
Adolescent egocentrism is a state of self-absorption in which the world is viewed as focused on oneself
Imaginary audience
Personal fables

Imaginary audience
Belief that one is center of everyone else's concern and attention
Personal fables
Egocentric belief that one's experiences are unique
Assessment methodology
May be right about existence of adolescent egocentrism but wrong about underlying processes

Thinking about Thinking…

Metacognition improves during adolescence

Thinks about own thoughts  self-consciousness
Monitors own learning processes more efficiently
Paces own studying

School Performance

True or False?

Grades awarded to high school students have shifted upward in the last decade.

True

The mean grade point average for college-bound seniors was 3.3 (out of a scale of 4), compared with 3.1 a decade ago. More than 40 percent of seniors reported average grades of A+, A, or A- (College Board, 2005).
Independent measures of achievement, such as SAT scores, have not risen. Consequently, a more likely explanation for the higher grades is the phenomenon of grade inflation. According to this view, it is not that students have changed. Instead, instructors have become more lenient awarding higher grades for the same performance.
Ask: What consequences does this have (potentially) for college-bound students?

School Performance

Do higher grades mean smarter students?

Independent measures of achievement, such as SAT scores, have not risen
Consequently, a more likely explanation for the higher grades is the phenomenon of grade inflation
According to this view, it is not that students have changed, but grades have been inflated

This is future supported by comparison of U.S. students to those in other countries

Students Around the World

Figure 11-6 U.S. 15-Year-Old Performance

Compared with Other Countries

When compared to the academic performance of students across the world, U.S. students perform at below-average levels.

(Source: Based on National Governors Association,

2008.)

Ask: Why do you think US students performance is lower than that of students in other parts of the world?
Less time spent in classes and less intensive instruction
The broad diversity of the U.S. school population
Differences in socioeconomic status

The Lazy Days of Summer

Summer learning loss

Socioeconomic differences

Remedy

Summer enrichment programs
Stealth learning/Not traditional summer school

Socioeconomic Status and School Performance

Individual Differences in Achievement

Children living in poverty lack many advantages
Later school success builds heavily on basic skills presumably learned or not learned early in school

There are several reasons. For one thing, children living in poverty lack many of the advantages enjoyed by other children. Their nutrition and health may be less adequate. Often living in crowded conditions and attending inadequate schools, they may have few places to do homework. Their homes may lack the books and computers commonplace in more economically advantaged households.

Ethnic and Racial Differences in School Achievement

Significant achievement differences between ethnic and racial groups

On average, African American and Hispanic students tend to perform at lower levels, receive lower grades, and score lower on standardized tests of achievement than Caucasian students
Asian American students tend to receive higher grades than Caucasian students

What is the source of such ethnic and racial differences in academic achievement?

Ask: What do you think?
Much of the difference is due to socioeconomic factors.
More African American and Hispanic families live in poverty so their economic disadvantage may be reflected in their school performance.
Members of certain minority groups may perceive school success as relatively unimportant: may believe that societal prejudice in workplace will dictate that they will not succeed, no matter how much effort they expend.
Attributions effect.
Beliefs about the consequences of not doing well in school.
Process of involuntary immigration apparently leaves lasting scars, reducing the motivation to succeed in subsequent generations.

Achievement Testing in High School: Will No Child Be Left Behind?

No Child Left Behind Act

Passed by Congress in 2002, requires that every U.S. state design and administer achievement tests that students must pass in order to graduate from
high school
Schools are graded so that the public is aware of which
schools have the best (and worst) test results

Unintended consequences

Teaching to test
Approaches to teaching designed to foster creativity and critical thinking discouraged
Anxiety level raised in students

Adolescent Media Usage

Kaiser Family Foundation survey

Young people spend an average of 6.5 hours a day with media
Around a quarter of the time they are using more than one form of medium simultaneously, they are actually being exposed to the equivalent of 8.5 hours per day
Some teenagers send nearly 30,000 texts a month

See Figure 11-7 for additional information on teenagers, cell phones, and texting

The Downside of Click

Objectionable material available
Growing problem of Internet gambling
Safety
Digital divide

Poorer adolescents and members of minority groups have less access to computers than more affluent adolescents and members of socially-advantaged groups—a phenomenon known as the digital divide.

Dropping Out of School

Adolescents leave school for variety of reasons

Males are more likely to drop out of school than females
Hispanics and African American students still are more likely to leave high school before graduating than non-Hispanic white students
Not all minority groups show higher dropout rates: Asians, for instance, drop out at a lower rate than Caucasians
Poverty plays larger role in higher dropout rate

Review and Apply

formal operations; abstract reasoning
quantitative; gradual; memory
metacognition

Review and Apply

egocentrism; imaginary audience
personal fables
socioeconomic; race; ethnicity

Review and Apply

THREATS TO ADOLESCENTS’ WELL-BEING

Adolescent Drug Use

One in 15 high school seniors smokes marijuana on a daily or near-daily basis
Marijuana usage has increased over the last few years
Daily marijuana use is at a 30-year high for high school seniors

How Common is Illegal Drug Use during Adolescence?

Figure 11-8 Downward Trend

According to an annual survey, the proportion of students reporting marijuana use over the past 12 months has decreased since 1999.

What might account for the decline in drug use?

(Source: Johnston et al., 2011.)

Why Do Adolescents Use Drugs?

Pleasurable experience
Escape
Peer pressure
Enhanced academic performance

Why Do Adolescents Use Drugs?

Biological and psychological addiction

Addictive drugs are drugs that produce a biological or psychological dependence in users, leading to increasingly powerful cravings for them.

Addictive drugs are drugs that produce a biological or psychological dependence in users, leading to increasingly powerful cravings for them.
Biological addiction presence in body becomes so common that body is unable to function in their absence; causes actual physical—and potentially lingering—changes in nervous system. drug intake no longer may provide a “high,” but may be necessary simply to maintain the perception of everyday normalcy.
Psychological addictiondepend on drugs to cope with everyday stress of lifeprevent adolescents from confronting—and potentially solving— problems that led them to drug use in first place.

Why do adolescents use drugs?

Psychological addictiondepend on drugs to cope with everyday stress of lifeprevent adolescents from confronting—and potentially solving— problems that led them to drug use in first place.

Biological addiction presence in body becomes so common that body is unable to function in their absence; causes actual physical—and potentially lingering—changes in nervous system. drug intake no longer may provide a “high,” but may be necessary simply to maintain the perception of everyday normalcy.

Addictive drugs are drugs that produce a biological or psychological dependence in users, leading to increasingly powerful cravings for them.
Biological addiction presence in body becomes so common that body is unable to function in their absence; causes actual physical—and potentially lingering—changes in nervous system. drug intake no longer may provide a “high,” but may be necessary simply to maintain the perception of everyday normalcy.
Psychological addictiondepend on drugs to cope with everyday stress of lifeprevent adolescents from confronting—and potentially solving— problems that led them to drug use in first place.

Alcohol: Use and Abuse

Figure 11-9 Binge Drinking Among College Students

For men, binge drinking is defined as consuming

five or more drinks in one sitting; for women, the total is four or more.

Why is binge drinking

popular?

(Source: Wechsler et al., 2003.)

Binge Drinking Effects on Brain

Binge drinking affects certain areas of the white matter of the brain, as shown in this scan.

(Source: McQueeny et al., 2009, Figure 2)

Binge drinking affects even those who don’t drink or drink very little.
Two-thirds of lighter drinkers reported that they had been disturbed by drunken students while sleeping or studying.
Around a third had been insulted or humiliated by a drunken student, and 25 percent of women said they had been the target of an unwanted sexual advance by a drunk classmate.

Why do adolescents start to drink?

Genetics
Way of proving themselves
Release of inhibitions and tension and reduction of stress
False consensus effect

From Activity to Addiction

Adolescent alcoholics

Alcohol use becomes uncontrollable habit
Increasing ability to tolerate alcohol
Increasing need to drink ever-larger amounts of liquor to bring about positive effects craved

Alcoholics, those with alcohol problems, learn to depend on alcohol and are unable to control their drinking.
Reasons for addiction not understood.
Genetics
Stress
Environment

Hooked on Drugs or Alcohol?

Signals

Identification with the drug culture
Signs of physical deterioration
Dramatic changes in school performance
Changes in behavior

(Adapted from Franck & Brownstone, 1991, p. 593–594)

Identification with the drug culture

Drug-related magazines or slogans on clothing

Conversation and jokes that are preoccupied with drugs

Hostility discussing drugs

Collection of beer cans

Signs of physical deterioration

Memory lapses, short attention span, difficulty concentrating

Poor physical coordination, slurred or incoherent speech

Unhealthy appearance, indifference to hygiene and grooming

Bloodshot eyes, dilated pupils

Dramatic changes in school performance

Marked downturn in grades—not just from C's to F's, but from A's to B's and C's; assignments not completed

Increased absenteeism or tardiness

Changes in behavior

Chronic dishonesty (lying, stealing, cheating); trouble with the police

Changes in friends; evasiveness in talking about new ones

Possession of large amounts of money

Increasing and inappropriate anger, hostility, irritability, secretiveness

Reduced motivation, energy, self-discipline, self-esteem

Diminished interest in extracurricular activities and hobbies (Adapted from Franck & Brownstone, 1991, p. 593–594.)

National Institute on Drug Abuse at (800) 662-4357 or website at www.nida.nih.gov.

Tobacco: The Dangers of Smoking

Incidence
Differences
Gender
International
Racial

Most adolescents are well aware of the dangers of smoking, but many still indulge in it.
Overall, smaller proportion of adolescents smoke than in prior decades, but numbers remain substantial.
Within certain groups numbers are increasing.
Smoking is on the rise among girls, and in several countries, including Austria, Norway, and Sweden, the proportion of girls who smoke is higher than the proportion of boys.
There are racial differences.
White children and children in lower socioeconomic status households are more likely to experiment with cigarettes and to start smoking earlier than African American children and children living in higher socioeconomic status households.
Significantly more white males of high school age smoke than do African American males in high school, although the differences have narrowed in recent years.

Why do adolescents begin to smoke and maintain the habit?

Advertisements in the media
Addiction
Parent and peer models
Adolescent rite of passage

Selling Death: Pushing Smoking to the Less Advantaged

Tobacco companies carve out new markets by turning to least advantaged
Tobacco companies aggressively recruit adolescent smokers abroad

According to the World Health Organization, smoking will prematurely kill some 200 million of the world's children and adolescents, and overall, 10 percent of the world's population will die because of smoking.

Sexually Transmitted Infections

AIDS

Leading cause of death among young women worldwide
Already, over 25 million people have died from AIDS worldwide, and people living with the disease number 34 million worldwide

African Americans and Hispanics account for 70 percent of new AIDS cases,
African American males have almost 8 times the prevalence of AIDS as white males

AIDS Around the World

The number of people carrying the AIDS virus varies substantially by geographic region. By far the most cases (Source: UNAIDS & World Health Organization, 2009.)

Other Sexually Transmitted Infections

The most common STI is human papilloma virus (HPV). HPV can be transmitted through genital contact without intercourse. Most infections do not have symptoms, but HPV can produce genital warts and in some cases lead to cervical cancer. A vaccine that protects against some kinds of HPV is now available. The U.S. Centers for Disease Control and Prevention recommends it be routinely administered to girls 11 to 12 years of age—a recommendation that has provoked considerable political reaction (Friedman et al., 2006; Kahn, 2007).
Another common STI is trichomoniasis, an infection in the vagina or penis, which is caused by a parasite. Initially without symptoms, it can eventually cause a painful discharge. Chlamydia, a bacterial infection, initially has few symptoms, but later it causes burning urination and a discharge from the penis or vagina. It can lead to pelvic inflammation and even to sterility. Chlamydial infections can be treated successfully with antibiotics (Nockels & Oakshott, 1999; Favers et al., 2003).
Genital herpes is a virus not unlike the cold sores that sometimes appear around the mouth. The first symptoms of herpes are often small blisters or sores around the genitals, which may break open and become quite painful. Although the sores may heal after a few weeks, the infection often recurs after an interval, and the cycle repeats itself. When the sores reappear, the infection, for which there is no cure, is contagious.
Gonorrhea and syphilis are the STIs that have been recognized for the longest time; cases were recorded by ancient historians. Until the advent of antibiotics, both infections were deadly. However, today both can be treated quite effectively.

Sexually Transmitted Infections (STIs) Among Adolescents

Why are adolescents in particular in danger of contracting an STI? (Sources: Alan Guttmacher Institute, 2004; Weinstock, Berman, & Cates, 2006.)

Avoiding STIS

Review and Apply

pleasure; pressure; approval
alcohol; inhibitions
smoking

Review and Apply

AIDS
sexual abstinence; ignore
chlamydia; genital herpes; trichomoniasis; gonorrhea; syphilis

Review and Apply

EPILOGUE

Before turning to the next chapter, return for the moment to the opening prologue of this chapter, about Beth and Bryce Chadwick's the following questions about Peter.

Is Beth Chadwick right to be worried about the changes she sees in her son Peter?
Is Peter Chadwick's withdrawal from his family normal for a boy his age? Why might he be spending so much time in his room with the door closed?
What other changes might be occurring to Peter apart from the behavioral and personality changes mentioned by his parents?

EPILOGUE

What factors might be influencing Peter's declining school performance?

What advice would you give Peter's parents to deal with the changes they see in Peter?